ABSTRACT
This article discusses the case of a 47-year-old woman who underwent primary therapy with curative intent for breast cancer. The case illustrates a number of failure events in transferring information and responsibility from oncology to primary care teams. The article emphasizes the importance of shared leadership, as multiple team members, dispersed in time and space, pursue their own objectives while achieving the common goal of coordinating care for survivors of cancer transitioning across settings. Shared leadership is defined as a team property comprising shared responsibility and mutual influence between the patient and the patient's family, primary care providers, and oncology teams, whereby they lead each other toward quality and safety of care. Teams, including the patient-family, should achieve leadership when their contribution is relevant in managing task interdependence during transition. Shared leadership fosters coordinated actions to enable functioning as an integrated team-of-teams. This article illustrates how shared leadership can make a difference to coordinate interfaces and pathways, from therapy with curative intent to the follow-up and management of survivors of breast cancer. The detailed case is elaborated as a clinical vignette. It can be used by care providers and researchers to consider the need for new models of care for survivors of cancer by addressing the following questions. Who accepts shared leadership, how, with whom, and under what conditions? What is the evidence that supports the answers to these questions? The detailed case is also valuable for medical and allied health professional education.
Subject(s)
Leadership , Patient Care Team/organization & administration , Breast Neoplasms/therapy , Cooperative Behavior , Female , Humans , Interprofessional Relations , Medical Oncology , Middle Aged , Primary Health Care , SurvivorsABSTRACT
OBJECTIVE: To formulate a nutrient supplement using low cost, commonly available food ingredients and test its efficacy on various nutritional parameters in haemodialysis (HD) subjects. DESIGN: Prospective intervention study. SUBJECTS: 15 subjects who did not have diabetes were recruited for the study. The subjects served as self controls. APPROACH: The subjects received a multi-nutrient formulation for a period of 3 months. Somatic status [weight, mid upper arm circumference (MUAC), mid upper arm muscle circumference (MUAMC), waist and hip measurements], biochemical parameters [blood urea nitrogen (BUN), total iron binding capacity (TIBC),serum levels of creatinine, albumin, triglycerides, sodium, potassium, calcium, phosphorus and high sensitive C-reactive protein(HsCRP)], dietary intake and malnutrition inflammation score (MIS) were assessed. RESULTS: Significant increments (P ≤ 0.01) in anthropometric measurements. Significant increases (P ≤ 0.01) in Hb, BUN, serum creatinine, albumin and total protein and a significant decrease (P ≤ 0.01) in HsCRP and MIS were observed at the end of the study. An increase in baseline food/nutrient intake was also observed. CONCLUSION: Nutritional supplementation designed for haemodialysis, improved their nutritional status in the short term study.
Subject(s)
Developing Countries , Malnutrition/nursing , Nutritional Status , Renal Dialysis/nursing , Adult , Aged , Anthropometry , Female , Food, Formulated , Humans , India , Male , Malnutrition/diagnosis , Middle Aged , Nursing Assessment , Nutrition Assessment , Nutritional Requirements , Prospective StudiesABSTRACT
Distance learning offers a distinctive environment to educate nursing students. While there is a significant body of evidence in the literature related to course, program, and faculty outcomes of distance education, little attention has been given by researchers to evaluate student outcomes, with the exception of student satisfaction. There is a need to evaluate and translate findings related to student outcomes in distance learning into educational practice. Integrative reviews offer one strategy to contribute to evidence-based teaching practice initiatives. A search of available published qualitative and quantitative research on student outcomes of distance learning from 1999 to 2009 was conducted using a number of databases. Astin's Input-Environment-Output conceptual model provided a framework for this review. Thirty-three studies met the inclusion criteria. Bothcognitive and affective student outcomes emerged. The cognitive outcomes were student learning, learning process, and technology proficiency. Affective outcomes included personal and professional growth, satisfaction, and connectedness. Implications, recommendations, and future research are discussed.
